California Cardiac Surgery Intervention Project

Summary of Isolated CABG Model based on California Inpatient Discharge Data, 2013-2014

Outcome:MACCE (Multiple Adverse Cardiovascular and Cerebral Events)
This outcome is determined based on the occurrence of 1 or more of the following events after the index surgery or a subsequent inpatient-readmission connected through the surgery admission via acute transfer:
  • Death during the surgery admission or during a connected inpatient re-admission; disposition code '11' is used to identify in-hospital deaths.
  • Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during a connected inpatient re-admission; ICD-9-CM codes used to identify MIs: 410.xx.
  • Post OP Stroke defined as stroke during the surgery admission that was not present at admission or stroke during a connected inpatient re-admission; ICD-9-CM codes used to identify Strokes: 997.02, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91.
  • Re-Intervention defined as any cardiac surgery / intervention during the index surgery admission that occurred at least 1 day after the index surgery or a cardiac surgery / intervention during a connected acute inpatient re-admission. Any procedure in the range 35.xx-38.xx that was performed using ECC (ICD-9-CM procedure code 39.61) is considered a re-intervention. Furthermore, any off-pump CABG procedure (36.1) or any PCI (36.01, 36.02, 36.05, 36.06, 36.09, 00.66) is also considered a re-intervention.
All events are weighted equally.
Model Statistics:
Number of Observations: 24,209
% of Observations with Outcome: 5.5%
C-statistic: 0.717Pseudo-R2: 10.5Hosmer-Lemeshow P-Value: 0.033
Model Details:
Risk Factor N Cases % Events Estimate Standard Error Wald Chi2 P-value Odds Ratio (OR) Lower 95% CL for OR Upper 95% CL for OR
Intercept
-3.7
0.1
1620.4
0.000
Age at Admission18-<50
1,847
4.0
-0.2
0.1
3.0
0.084
0.8
0.6
1.0
50-<55
1,710
4.5
-0.1
0.1
0.5
0.483
0.9
0.7
1.2
55-<60
3,122
4.8
0.0
0.1
0.1
0.702
1.0
0.8
1.2
60-<65
3,953
4.7
-0.1
0.1
0.5
0.493
0.9
0.8
1.1
65-<70
4,636
5.1
Reference
70-<75
3,638
6.1
0.1
0.1
2.0
0.153
1.2
0.9
1.4
75-<80
2,979
5.8
0.1
0.1
0.4
0.507
1.1
0.9
1.3
80 or older
2,324
9.3
0.5
0.1
20.6
0.000
1.6
1.3
2.0
Patient SexMale
18,597
5.0
Reference
Female
5,612
7.3
0.3
0.1
19.6
0.000
1.3
1.2
1.5
RaceOther race
3,680
5.2
0.0
0.1
0.0
0.978
1.0
0.8
1.2
White
16,298
5.5
Reference
Black
1,018
5.6
0.0
0.1
0.1
0.811
1.0
0.7
1.3
Asian/Pacific Islander
3,213
5.8
0.1
0.1
1.8
0.177
1.1
0.9
1.3
EthnicityHispanic
5,070
5.3
0.0
0.1
0.3
0.589
1.0
0.8
1.1
Non-Hispanic
19,139
5.6
Reference
Acute MI Present at Scheduled Admission
1,301
4.8
-0.1
0.1
0.7
0.402
0.9
0.7
1.2
Acute MI Present at Unscheduled Admission
7,739
6.8
0.0
0.1
0.2
0.643
1.0
0.9
1.2
Aortic/Mitral Valve Disease/Stenosis/Insufficiency
287
7.7
0.1
0.2
0.1
0.732
1.1
0.7
1.7
Atrial Fibrillation and Flutter
2,783
7.2
0.1
0.1
1.1
0.288
1.1
0.9
1.3
Cardiogenic Shock
693
15.9
0.8
0.1
40.3
0.000
2.2
1.7
2.8
Cardiomyopathy
1,259
7.1
0.1
0.1
0.9
0.349
1.1
0.9
1.4
Heart Failure
5,650
7.9
0.3
0.1
22.3
0.000
1.4
1.2
1.6
HX Sudden Cardiac Arrest (Begin 2007)
157
1.9
-1.1
0.6
3.5
0.060
0.3
0.1
1.0
Chronic Lung Disease
3,115
6.5
0.1
0.1
1.0
0.309
1.1
0.9
1.3
Cerebrovascular Disease
1,959
8.5
0.5
0.1
28.5
0.000
1.6
1.4
1.9
Diabetes
12,215
5.7
0.0
0.1
0.5
0.493
1.0
0.9
1.2
Dialysis
665
11.6
0.5
0.1
15.0
0.000
1.7
1.3
2.3
Number of GraftsOne
1,142
19.2
1.5
0.1
281.5
0.000
4.4
3.7
5.2
Two
3,999
6.0
0.2
0.1
7.8
0.005
1.2
1.1
1.4
Three or More
19,068
4.6
Reference
PCI prior to Admission
4,482
4.9
-0.1
0.1
1.2
0.279
0.9
0.8
1.1
Prior PCI on same Day as Surgery
352
23.5
0.8
0.2
25.8
0.000
2.2
1.6
2.9
Pre-Op Intra-Aortic Balloon Pump
1,732
16.0
1.1
0.1
139.0
0.000
2.9
2.5
3.5
Prior CABG/Valve Surgery
471
8.1
0.2
0.2
0.7
0.387
1.2
0.8
1.7
Peripheral Vascular Disease
4,178
7.0
0.1
0.1
2.5
0.113
1.1
1.0
1.3
Renal Failure
5,361
8.2
0.4
0.1
28.3
0.000
1.5
1.3
1.7
Status of Procedure Urgent
734
15.1
0.2
0.1
2.1
0.151
1.2
0.9
1.6
Notes:
If a patient had more than one surgery event of the same type on different dates during the index admission, only the surgery on the earliest date is included for fitting the model.
CL: Confidence Limit
CABG: Coronary Artery Bypass Graft
PCI: Percutaneous Coronary Intervention